The Healthcare Hustle

Gabrielle is the Care Coordinator for Persist Health Project. Persist Health Project is a peer-led, community-based health and community organizing project for sex workers based in Brooklyn, New York. As Persist’s Care Coordinator, Gabrielle vets service providers, provides community members with supportive referrals, and helps lead Persist’s Best Practices Trainings.

While many of us dream of the ideal client who will deposit money annually into our retirement fund or enroll us in their kick-ass work health insurance plan, he probably won’t come along for all of us. Here are some things you can do to get quality health care service in the meantime without breaking the bank:

1. First things first, you could be eligible for government subsidized health insurance through Medicaid! Check with an Affordable Care Act (ACA/Obamacare) navigator to see if you are. You can also call a Medicaid Hotline (1-800-541-2831) to check your eligibility. If you make under $1,300 a month (for a single person, that number goes up with family size) in reported income, are pregnant, or have recently had a child, you may be eligible for Medicaid. If you have recently been diagnosed with HIV you are also eligible for AmidaCare through Medicaid.

While open enrollment for the ACA has ended, if you are eligible for Medicaid or government assistance with your health care plan you are still able to enroll without a fee. Reach out to Callen-Lorde Community Health Center if you think you might be eligible and get enrolled today!

2. Always ask your doctor if they are able to prescribe you the generic form of a medication. Generic medications equal cheaper medications! It’s also okay to ask for an explanation for why a specific drug is being prescribed and if taking the generic version of it would make a difference. Sometimes doctors are also willing to offer free samples of medications if they have them in stock. Don’t be afraid to ask!

3. If you are getting blood work without insurance or with limited insurance coverage, check out free clinics and testing sites throughout your area. Always check with your insurance to see if the testing site is covered or you could wind up stuck with a nasty bill.

You can also request that your doctor give you a Patient Financial Assistance Application which you can send to Quest Diagnostics, a testing company. By providing Quest with information regarding your income on this application, you could receive a 50%-75% discount on lab work.

4. Everyone is eligible for a rapid HIV test at a Department of Health (DOH) clinic. If you want to get a full STD panel from a DOH clinic you must be assessed as “high risk,” which means you need to check the box to indicate that you recently had sex with a man who has sex with men. You can also tell the clinic that you are exhibiting symptoms of an STI. Feel free to use an alias here as identification is not necessary. Bonus: Once you are in the DOH system, just by taking a rapid HIV test at one of their clinics, you are eligible for up to 12 free counseling sessions with their social workers. I have a few contacts for sex worker-friendly social workers at these clinics, so feel free to contact me at gabrielle@persisthealthproject.org if you are interested in setting this up.

5. Unless you’re dealing with a severed limb or some other life threatening injury, there’s no reason to waste your time in an ER. For things like fractured bones, pink eye, STIs and urinary tract infections, an urgent care center is probably your best option. If you don’t have insurance, call ahead and see how much your visit will cost you and make sure that they are equipped to treat you. It usually costs around $150-$200 dollars a visit to an urgent care center, compared to an ER visit which can run you anywhere from $600 to $1,300 a visit. However, if you are seeking pain management for an injury, most urgent care centers are not equipped to handle this and your best bet in that situation is an ER.

In either case, remember that the ER and Urgent Care Centers are busiest after 5PM. Look for more information regarding urgent care centers verse emergency rooms here.

6. If you are uninsured and find yourself in an ER, there are insurance navigators and translators to help you on staff. A navigator will meet with you and help see if you are eligible for Medicaid, and if so, get you enrolled. Medicaid coverage will start three months retroactively. So even if you are uninsured when you have an emergency, it’s possible your medical costs can still be covered by Medicaid. There is also something called Emergency Medicaid for undocumented folks, which you can now prequalify for. Check out more information on Emergency Medicaid here.

A lot of Persist Health Project’s referrals come from within the community. Your own best information about health care may come from your own community. When you see a provider you like, share their information with a friend! Same goes for tips on hustling the health care system.

Disclaimer: While the Department of Health and urgent care centers certainly serve their purpose, they aren’t my #1 choice for sex worker-friendly care. I would advise being wary about disclosing your experience in sex work to these institutions and focus on getting what you need out of the appointment. Bringing along a friend to advocate for you can be a great idea. If you you are looking for primary care physicians whom you can feel comfortable disclosing to, feel free to contact me. I have a handful of referrals for both folks with insurance and those without.

Gabrielle is the Care Coordinator of Persist Health Project, a pro-Domme, and a new-media artist living in NYC. As Persist's Care Coordinator, she provides community members with supportive referrals and vets Persist’s service providers. She also enjoys making art and making men cry.

This is a little bit confusing, but the general answer is that it shouldn’t matter for most people (at least for the next few years). Also, once you are enrolled in Medicaid, if you start earning more than the $1300- you are still covered for 12 months (unless new job offers insurance – then covered until that kicks in). Feel free to e-mail me if you want to talk a little bit more about this and I would encourage you to reach out to Callen-Lorde as well who are probably better equipped to answer any and all insurance navigation questions and get you enrolled if you like!